Effect of ferrotherapy on clinical and instrumental indices in patients with chronic heart failure with reduced left ventricular ejection fraction and concomitant latent iron deficiency

The objective of the study was to assess changes of clinical and instrumental indices in patients with chronic heart failure (CHF) with reduced left ventricular (LV) ejection fraction (EF) and concomitant latent iron deficiency (ID) on the background of the standard treatment in combination with 6-months oral ferrotherapy. 60 patients with CHF with reduced LV EF functional class (FC) II-III according to NYHA with concomitant latent ID were examined. Among them were 41 (68.3%) men and 19 (37.1%) women aged 68.3±0.63 years. Two groups of patients with CHF and latent iron deficiency were formed: the 1st group (n=30) received a standard therapy, the patients in the 2nd group (n=30) were additionally prescribed oral ferrous sulfate in a dose of 320 mg, equivalent to 100 mg of bivalent iron and 60 mg of ascorbic acid per day for 6 months. Number of red blood cells (Rbc), hemoglobin (Hb) level, serum iron (SI), ferritin, transferrin saturation (ТS), 6-minute walk stress test (6MWT), MLHFQ and MOS SF36 questionnaire and LV morpho-functional parameters by echocardiography were determined. The studied values are presented as a median (upper, lower quartile). After the therapy the values of Hb, Rbc, SI, ferritin and TS have significantly increased in the 2nd group. But in the 1st group due to the lack of ferrocorrection, in most cases, the values have reduced. An increase of the covered 6MWT distance, MLHFQ points, physical (PH) and mental (MH) components of health of MOS SF36 was observed in both groups: in the first group only by 5.3 (р=0.06), 1.2 (р=0.46), 6.9 (р=0.31) and 7.2% (р=0.02), respectively. Whereas in the second group by 13.8 (p<0.001), 13.6 (p<0.001), 24% (p<0.001) and 15% (p<0.001), respectively. EDD (end-diastolic dimension) decreased by 2.1% (p<0.001), EDV (end-diastolic volume) — by 4.8% (p<0.001), ESD (end-systolic dimension) — by 3.9% (p<0.001), ESV (end-systolic volume) — by 13.3% (p<0.0001), EF has increased by 12.7% (p<0.001) in the first group. No difference in the dynamics of the Echo-CG indices between two groups of patients over 6 months of observation was detected (р>0.18). EDD decreased by 2.7% (p<0.001), EDV — by 3.9% (p<0.0001), ESD — by 3.9%, ESV — by 10.9% (p<0.0001), EF has increased by 16.3% (p<0.0001).Thus, the positive hematological changes in case of latent ID correction in patients with CHF with reduced LV EF, despite the similar dynamics of myocardium morpho-functional indices in case of absent ferrocorrection, are accompanied by more significant positive dynamics of effort tolerance and quality of life.

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PERORAL FERROCORRECTION OF IRON DEFICIENCY IN PATIENTS WITH CHRONIC HEART FAILURE WITH REDUCED LEFT VENTRICULAR EJECTION FRACTION

Актуальні проблеми сучасної медицини Вісник Української медичної стоматологічної академії ◽

10.31718/2077-1096.19.3.31 ◽

2019 ◽

Vol 19 (3) ◽

pp. 31-36

Author(s):

V. P. Ivanov ◽

M. O. Kolesnyk ◽

O. M. Kolesnуk

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Left Ventricular Ejection Fraction ◽

Iron Deficiency ◽

Ejection Fraction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Latent Iron Deficiency ◽

Per Oral

Therapy of iron deficiency as a common comorbidity in chronic heart failure is being paid much attention. It plays contributory role in the morbidity and mortality of heart failure. However, there are some questions requiring future research to answer them. Nowadays, the parenteral administration of iron supplements has been considered as one of the effective approaches for the correction of the above-mentioned disorders, although per oral rout of ferrum administration is playing the leading role. Among the disputable questions there is duration of peroral ferrocorrection course for patients with latent iron deficiency. Taking into account some disadvantages of per oral ferrocorrection, e.g. slow absorption in the gastrointestinal tract or reduced absorption in conditions of even minimal inflammation or blood congestion, in order to improve the condition of the patients with chronic heart failure and concomitant latent iron deficiency, we decided to prolong the course of therapy in our study. The purpose of the study was to determine the effectiveness of 6-month per oral ferrotherapy in patients with heart failure with reduced left ventricular ejection fraction and concomitant latent iron deficiency. Material and methods. We examined 60 patients, 41 (68.3%) men and 19 (37.1%) women, aged 68.3 ± 0.63 years with chronic heart failure with reduced left ventricular ejection fraction functional class II-III according to NYHA, who were also diagnosed to have concomitant latent iron deficiency. Two study groups were formed: the patients of the 1st group (n=30) received only the standard therapy for chronic heart failure according to the European recommendations (2016); the patients of the 2nd group (n=30) were prescribed to take ferrous sulphate per orally in a dose of 320 mg, equivalent to 100 mg of bivalent iron and 60 mg of ascorbic acid 2 tablets per day for 6 months. Results and discussion. By the study’s end, anaemia was observed in 76.5% of patients. However, among these patients, 84.6% had latent iron deficiency and only 15.4% had complete cure of the iron deficiency. Thus, it was found out that without supportive therapy with iron medicines for 32.8±0.7 months after the end of iron deficiency, patients with chronic heart failure had negative laboratory dynamics. Analysis of the dynamics of haematological indices as markers of the ferrocorrection effectiveness in the patients who received the 6-month ferrotherapy demonstrated an increase of all parameters and normalization of iron metabolism indices. Moreover, 96.7% of the patients, who took standard therapy and ferrum medicines, demonstrated the elimination of iron deficiency signs. Conclusion. Thus, the study showed that per oral therapy with iron sulphate at the stage of latent iron deficiency in patients with heart failure with reduced left ventricular ejection fraction for a period of 6 months has been found out as effective.

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